Provider Demographics
NPI:1568046282
Name:MIAMI PRIMARY HEALTHCARE LLC
Entity Type:Organization
Organization Name:MIAMI PRIMARY HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MNG
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:VERGARA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:305-333-8623
Mailing Address - Street 1:7375 W 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-3710
Mailing Address - Country:US
Mailing Address - Phone:305-333-8623
Mailing Address - Fax:786-349-9000
Practice Address - Street 1:1275 W 47TH PL STE 307
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3447
Practice Address - Country:US
Practice Address - Phone:786-722-0999
Practice Address - Fax:786-349-9000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-09
Last Update Date:2021-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty